Book reviews

This book is written for parents of diabetic children, teachers and all those involved with the diabetic child. It's dimensions are 5" • 7Y~" • %" and thus it is unquestionably pocket-sized and it is extremely well presented. Professor Farquhar works in Edinburgh and undoubtedly his inimitable style, in addition to reflecting his own enthusiasm, also tells us something about the attitudes and outlook of his own patient studies over many years. While I have little doubt that his approach to the problem of diabetic children is appropriate for his own patients, I am less sure that it would be unreservedly well received by patients elsewhere. For example, I think many parents of newly diagnosed diabetic children would react unfavourably to the opening chapter which is titled 'Just diagnosed, here's the good news !' I also think it might be difficult for some patients to cope with the jolly tone of the first few pages, in and among which is to be found a description of ketosis and Kaussmaul breathing. It is no easy task to write a text for patients in simple English and often requires the invention of analogies to convey complicated ideas. Professor Farquhar's colourful and humorous style, with mixed metaphors, punctuated by phrases in italics and capital letters, is at least an original approach to this problem. It will be for the patients themselves to decide whether this approach is successful or not. In the section on food (and I was very pleased to see that this included scones and porridge), the body is likened to a gas cooker in which insulin is the flame converting gas into energy. Without a flame, we are told, there is a nasty smell (presumably a reference to ketones) and no energy. This is a characteristic example of the author's ingenuity; however, I am left in some doubt as to whether this is helpful or, conversely, too complex for the average family. The section on insulins is more straightforward. It is chatty, upto-date and quite clearly presents the personal views of the author. Perhaps he is right to interlace the past and present with his views of the future. For example, there are references to insulin infusion systems and U100 insulin in the middle of this chapter which, although unconventional, may be more effective in maintaining the interest of the reader than placing these future advances at the end. The chapter on eating is the best, combining clear advice together with a realistic sense of perspective for day to day living. The section on diabetic control is imaginatively entitled 'How do we know treatment is correct?' This is a useful chapter and I would only take issue with his recommendation for double urinary voiding as a routine for all patients. The short-term complications, particularly insulin reactions and diabetic ketoacidosis, are well presented with a suitably serious text. I was put off, however, to find that the next chapter was entitled 'Going home' indicating that as a new parent I was expected to have read this far before actually taking my child out of hospital. Most chapters in the book have particularly interesting and attention-catching titles, such as 'The crystal ball', 'Games diabetic children play' (referring to things like falsifying test results), 'Your good health', 'Travelling', and 'The family abroad'. I think this is potentially an useful book. I hope there will be a second edition with some re-ordering of the chapters and possibly with a division of the book into a short first part suitable for parents to read while the child is in hospital and a longer second section for study after they have grown accustomed to living with their diabetic child at home. J.D. Baum (Oxford)

Article ^r~~History of a Case oft diseased Spleen, with Appearances on Dissection. By Nathan Drake, M. D. liadleigh, Suf-folk.
Of this case we shall transcribe only the dissection, with a short remark of our own. " Appearances on Dissection.
1. " The coats of the stomach were nearly three times thicker than usual ; its cavity reduced to about one third of the customary size, the ruga? very distinct; the cardia and pylorus in a sound state ; but a little above tbe sphincter pylori there was a quantity, nearly an ounce, of cheese-like matter in a granulated form, adhering to the external coat of the stomach, but not constricting the passage into the duodenum ; there were no traces of inflammation either on the inner or outer coat of the stomach.
2. " The omentum was greatly enlarged, and entirely covered with cheese-like matter in a granulated state; considerable por-' tions of its substance were thickened to a full inch in depth, and were altogether formed of the same caseous material, which might be rubbed between the fingers into a paste, but somewhat gritty to the touch. The omentum was depressed far below its usual situation, and strongly and extensively adhered to the peritonaeum and intestines.
3. " The spleen was one mass of disease ; half of its proper bulk appeared to be absorbed or wasted, and the organization of the remaining part completely obliterated, and in a state approaching towards solution; the peritonceal coat of'its internal concave surface, was dilated into a very large cyst, with blood vessels of an enormous size, ramifying on its inferior part, or fundus.
The upper part of the cyst strongly adhered to the whole under surface of the stomach, and the lower part to the upper edge of the great arch of the colon. The diameter of the cyst was full six inches, and it contained more than a pound and a half of dark, dense, coagulated blood, several portions of which, nearly as large as a man's fiat, floated in a brown coloured serum, of which there was better than a pint. We have already related that two pints of a similar fluid had been drawn off, previous to death, and the capacity of the cyst was such as to admit of considerably more than four pints. The bottom and sides of this bag were covered about an inch deep, with a black tenacious matter of the consistence of congealed honey, and, when examined with the fingers, was found interspersed with masses of the same caseo-is substance, which covered the omentum.
The great size of the cyst prqssed the stomach high up, and close to the diaphragm, and the arch of the colon was, from the same cause, thrust down many inches below its natural situation, and was contracted in that part of its course to the size of a small intestine. There was no communication from this cyst with the liver, stomach, or intestines, and there was no fcetor, and no pus in any of the diseased viscera.

4.
" The liver was pressed high up by the bulk of the cyst, its H h 4 * lower lower edge being considerably within the margin of the thorax. It was perfectly sound and healthy in all its lobes, not a mark of disease appearing, either externally or internally. It was rather smaller than usual in size, and the left lobe could not be said to pass into any part of the left hypochondriac region, owing probably to the magnitude of the cyst. The lobulus spigelii was also in the most perfect state, and the gall Bladder was distended with bile, and of its proper colour.
5. " The intestines, with the exception of the arch of the colon, were nearly free from disease, but compressed into a very small compass, and adhering to the omentum. The blood vessels upon the arch of the colon were turgid, and part of the mesocolon was as much diseased as the omentum, being thickly interspersed with cheese-like matter in a granulated form. The arch of the colon was so reduced in bulk, and compressed, that when the body was opened, it projected like a chain of very small bladders.
6. " The kidneys, uterus,, and bladder, were in a sound state.

7.
" The thoracic viscera were also perfectly sound." In the course of our remarks on the various modes of practice, exhibited under different titles of cases, treatises, &c. we have often had occasion to regret the backwardness of our cotemporaries in the use of the lancet. It is not for us to doubt that every thing which could be done for the benefit of the patient, whose case is above related, was in this instance tried ; and if we had such doubts, we would suppress them rather than discourage such valuable and candid communications.
But when pain and sickness arc intense, our practice would always lead to immediate anil copious bleeding; nor have we ever found reason to repent it. Wc are the more ready to make this remark, because that remedy was tried, and the attendant physicians seem doubtful whether they had not better have omitted it.
Article 5.?Case of successful Amputation of the Uterus. By Joseph Clarke, M. D. Dublin. This paper is not less valuable, on account of the candour of the writer, who informs.us that the uterus having prolapsed was mistaken for a polypus, and as such, partly removed by ligature, and afterwardby the knife, when the disease was ascertained. The complete success of the operation will, we trust,' induce surgeons to have recourse to it in such cases of cancerous uterus as are well ascertained, and admit of no remedy but the forlorn refuge of the most distressed of human beings. By Henry Johnson, Fellow of the lloyal College of Surgeons, Edinburgh.
These cases have occurred so often, that to relate them can only be useful in those neighbourhoods where an imperfect knowledge of the events has injured this valuable discovery. We shall, therefore only transcribe the author's reflections. " Before concluding, I would beg leave to observe, that the practice of vaccine inoculation is beginning to be held by far too light ; any body is supposed capable of performing an operation so trifling. Every surgeon knows how frequently he produces an inflammation of several days standing with a pustular appearance, without supposing he gives constitutional infection, and security against small-pox. I fear such a simple affection of the arm, is too often considered as the real and necessary infection.
I am led to make this observation, from finding my own apprentices, when of very short standing indeed, frequently trying their siill in this Ayay." We perfectly agree with Mr. Johnson, that no one should undertake to vaccinate without a practical knowledge of the subject. But all the practical knowledge requisite appears to us a frequent sight of the vesicle in all its stages, with those few remarks'from, an experienced practitioner, which are easily retained by a learner of common attention. The various engravings which have at different times been offered to the public, have, in our opinion, done more harm than benefit.
When the subject was new, such an illustration was proper and necessary for general information, and on account of the interest it excited. But, for practical purposes, nothing should be made use of but the best means of information. Article 8.?Case of Epilepsy cured by TrepanningBy IIenry Cootes, of the Royal College of Surgeons in London, and Surgeon to the Salisbury Infirmary. This should have been entitled " Case of Epilepsy,, occasioned by an injury to the cranium, cured by trepanning^/owr years after the accident.
The paper is valuable, but as all such cases are to be considered as llecords, their utility is much increased by bringing forward the most remarkable circumstances attending them.
Article f).~ Cases of Idiopathic Tetanus, rath Observations. By C. L.
M ursinn a, Chief Surgeon to the Charite of Berlin.
Journal fur die Chirurgie, &c." But we arc not now to be taught that opium will sometimes cure locked jaw, especially when unconnected with a wound. Unfortunately also, we know how often it fails. Cases of this kind are well worth reading: but, when recorded, not of sufficient importance to find a place in two different Journals.
Article 10.?Contains some judicious Remarks ' 'On the Vlan of Medical Reform The Enquirer adds his mite at the conclusion of the original articles.
" On the Study of Mental Pathology/' The remarks on the difficulty with which this branch of mcdicine is attended are neither new, nor to be disputed any more than the imperfections of most of the plans hitherto pursued. But, when the writer assures us with confidence, that the principles of moral philosophy and metaphysics haye been much advanced in modern times, we confess ourselves much at a loss to discover these advances.
As to moral philosophy, we old-fashioned people are apt to be satisfied with the examples recorded of the Founder of our religion and his followers ; and as to metaphysics, such is the Beotian dulness of most of us, that we. are apt to rise from a grave discourse on these subjects, either without understanding our author, or, if we do understand him, with discovering that we have learned nothing but what was familiar to every thinking mind, before the writer dressed it in Mich a fashion, as to render it nearly obscure. We were somewhat gratified with the conclusion of the paper; not because it taught us any thing, but because it convinced us that the author, like ourselves, had every thing to learn. " After these cursory remarks, it might have been proper, shortly, to state the advantages which are likely to accrue from examining the brain, and other organs, of those persons, who have been affected with mental disorders.
But this field comprises so many important topics of discussion, that little benefit could be derived from any thing, which could be advanced here. Some of the principles, however, which should guide our researches into this subject, may probably be inferred from several of the preceding speculations. " I have thus attempted to give a rough outline of a great and important subject ; a subject, which not only involves consequences peculiarly interesting to the practical physician, but to every man who is anxious to acquire a scientific knowledge of human nature." We mean not to undervalue such disquisition, and are free to acknowledge, our own sheets are not always as full of information as we could wish. But, from the gravity of the Enquirer, we are apt to expect something more pointed. These are all the original articles. The Review is useful in containing analyses of several foreign works. We hope the whole of Professor Reil's proposals for 44 instructing a set of popular practitioners in the common routine routine of practice" will be translated. We recommend it to h? circulated by the Reforming Society, as a means of adding something more to their Reports, than a mere tedious detail of the irvsufficiency of practitioners in various parts of the country. Every medical man is aware how desirable some reform would be ; but if competition is the spirit of improvement, we must be careful hot to lay the foundations of monopoly.
The Vac civ. t Contest ; or, " Mild Humanity, Reason, Religion, and Truth, against fierce, unfeeling Ferocity, overbearing Insolence, mortified Pride, false Faith, and Desperation being an exact Outline of the Arguments and interesting Facts, adduced by the principal Combatants on both Sides, respecting Co-w-pox Inoculation, including a late ojficial Report on this Subject, by the Medical Council of the Royal Jennerian Society : chiefly designed for the Ufe of Clergymen, Heads of Families, Guardians, Overseers of the Poor, and other unprofejjional Readers, ivho may be concerned for tbe W elf are of Mankind.
By William Blair, M. A. Surgeon of the" Lock Hospital and Asylum, the Bloomsbury Dispensary, and New Rupture Society, Member of the Royal College of Surgeons, and of the Medical Societies of London, Paris, Brussels, Aberdeen, &c. &c. Svo. Murray, London. The words in this long title page, which are included within commas, are taken from Dr. Rowley's publication, against which tlra present performance is chiefly directed. The manner in which this has been undertaken, and the motives which gave rise to it, are explained in the following paragraph, extracted from the preface. " A mere glance at this book awakened attention ; and a deli-? berate perusal of it, suggested the idea of turning against an implacable adversary the murderous weapons which he himself had provided for a different purpose. The author judged it would not be lost time, though a nauseous and revolting task, to extract the marrow or quintessence of that extraordinary performance; and, by ?placing the Doctor's own language in a new and vivid light, to afford a spirited and glowing picture of its genuine deformities. The real character and motives of an opponent, who is so entirely devoid of justice and decorum, cannot be better discovered, than by dissecting, analysing, and exposing to public view, what may be called the vitals and sinews, the internal springs, the peculiar features and tone of his composition. And, if it should be found, that his character and motives are far from pure, except in his own eyes, it may be questioned whether his pretended Truths be unexceptionable, or his at/edged Facts such as honesty demands." The work is formed into a dialogue between a country Curate, Dr. Bragwell, and a town Surgeon. The first applies to Saville Row for further particulars relative to the Doctor's objection against the cow-pox. This produces such a conversation as might be expected : though the feeble arguments of Dr. Bragwell only confirm , confirm the clergyman in his good opinion of vaccination ; yet, to .bring forward parts of the subject unknown to one, and untouched .by the other, the Surgeon is at this moment introduced as an interlocutor ; we shall select a passage from this part of the work, to give our readers a specimen of the manner in which the whole it conducted.
Surgeon.?Reverend Sir, I greatly approve of your determination, and I hear witness this day to the ingenuousness and candour of your deportment towards Dr. Bragwell ; of whom, and to whom, I am come at present to say a'few words. I am a sur- the opposers cf cow-pox are ready to meet its advocates, being secure of a glorious victory." Surgeon.?Be assured, that if ever you .meet them, it will be to your confusion and disgrace: but, such a meeting is needless; for, your heap of anti-vaccinarianism is before the public. You have raked together into one mass (a disgusting collection !) all the conjectures or hearsay tales, all the pretended cases of failure or disaster, which any person would communicate for the gratification of your vanity ; with all the adverse facts hitherto published by others, though answered again and again. So that, whoever gives you, Dr. Bragwell, a proper reply, will have refuted the objections of every adversary that has appeared in this combat.
Doctor.?Well, well, Sir ; go on with your invective. " -{ liave no time for controversy." The Truth liies in a narrow compass. You have, of course, read my collection of Facts, ,and examined them attentively. Very true, Mr. Surgeon ; in refuting me, you will vanquish the whole host "of Anti-vaccinarians.
Did you ever hear of the " Anti-vaccinarian Society ?
Surgeon.?I am happy to have an opportunity of telling you, and this Reverend Gentleman, (whose patience equals his liberality of sentiment,) that your " Matters of Fact," and the " Antivaccinarian Society," of. which you are known to be the J'uc tot-Ufa, disgrace the medical profession ; and impeach the moral